Related Experiment Video
Updated: Jul 10, 2026
12:27
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Methods of vascular occlusion for elective liver resections
K S Gurusamy1, Y Kumar, D Sharma
1Royal Free and University College School of Medicine, University Department of Surgery, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG. kurinchi2k@hotmail.com
The Cochrane Database of Systematic Reviews
|October 19, 2007
Summary
Vascular occlusion during liver resection reduces blood loss but may increase liver dysfunction. Intermittent portal triad clamping is safe and supported by evidence, while hepatic vascular exclusion is not recommended. Ischaemic preconditioning may shorten hospital stays.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Vascular occlusion is a technique used to minimize blood loss during liver resection surgery.
- Controversy exists regarding the efficacy and optimal methods of vascular occlusion in elective liver resections.
- The role of ischemic preconditioning prior to vascular occlusion is also debated.
Purpose of the Study:
- To evaluate the benefits (reduced blood loss, peri-operative morbidity) and drawbacks (ischemia-induced liver dysfunction) of vascular occlusion in liver resections.
- To compare different vascular occlusion techniques against continuous portal triad clamping regarding blood loss and ischemia-reperfusion injury.
Main Methods:
- Systematic review of randomized clinical trials sourced from Cochrane Hepato-Biliary Group, CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded.
- Included trials compared vascular occlusion versus no occlusion, different vascular occlusion methods, and ischemic preconditioning.
- Data extraction included mortality, morbidity, blood loss, transfusion needs, liver function tests, and hospital stay; analyzed using fixed-effect and random-effects models.
Main Results:
- Vascular occlusion significantly reduced blood loss but elevated liver enzymes compared to no occlusion.
- No significant differences were observed in mortality, liver failure, or overall morbidity between occlusion methods.
- Intermittent portal triad clamping showed no increase in blood loss or operating time versus continuous clamping.
- Ischemic preconditioning demonstrated reduced liver enzymes, shorter intensive therapy unit, and hospital stays, with lower blood loss and transfusion requirements.
Conclusions:
- Intermittent vascular occlusion appears safe for liver resection but does not significantly decrease morbidity.
- Intermittent portal triad clamping is the most evidence-supported method for clinical application.
- Hepatic vascular exclusion is not recommended for routine use.
- Ischemic preconditioning before continuous portal triad clamping may offer clinical advantages in reducing hospital stay.
